Each year, Alabama spends $4 billion on health care for its 100,000 state employees. Aiming to alleviate some of that load in the future, the state Employees' Insurance Board approved a new plan that will charge state employees who do not try to improve medical conditions considered risky, such as obesity, high blood pressure and diabetes, a fee for their medical insurance. "It is really about investing in the employee. The program creates incentives and knocks down barriers needed to improve health conditions," said William Ashmore, Chief Executive Officer of the Alabama State Employees' Insurance Board. "Ultimately, we want to see the 10-15 percent of people currently at risk go down, creating less strain on the overall health-care system." Alabama state employees will be screened for medical conditions starting in January of 2010, and if health-care risks exist, employees have to show health improvement progress or they will begin paying $25 per month for their insurance starting in January of 2011. The state could have an annual net savings of $250 million, a return of investment of 5.6 to 1, over the next five years. While some are not in favor of Alabama's new insurance regulation, 45 states currently allow using obesity and health status in determining risk factors that could cause denial of coverage or an increase in insurance premiums.